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Posterior Triangle (posterior + triangle)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

Elective treatment of the neck in squamous cell carcinoma of the larynx: Clinical experience

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2003
Giuseppe Spriano MD
Abstract Background. In head and neck cancer, the best prophylactic treatment for the N0 neck is a subject of debate. Some authors propose lateral selective lymph node dissection (levels II,IV) on the basis of the probability of finding occult metastases in those lymph nodes. A more extensive procedure including Vth level is considered unnecessary because of the low incidence of metastases in the posterior triangle. Methods. We retrospectively evaluated 346 N0 patients affected by laryngeal carcinoma and consecutively treated at the Department of Otorhinolaryngology of the Ospedale di Circolo, Varese, Italy. The patients underwent elective selective neck dissection (levels II,V) for a total of 602 dissected heminecks. Result. Seventy heminecks (11.6%) were pN+, and in 10 of 70 cases (14.3%) level V was involved; in 5 of 10 metastases were isolated. Conclusion. Our retrospective study confirms the probabilistic criteria of the incidence of occult metastasis by level in laryngeal cancer. On the basis of our data Vth level nodes, although very rarely, 10 of 604 (1.6%), are involved with laryngeal cancer. Our approach to routinely dissect Vth level nodes is discussed. © 2003 Wiley Periodicals, Inc. Head Neck 25: 97,102, 2003 [source]

Shoulder Disability After Different Selective Neck Dissections (Levels II,IV Versus Levels II,V): A Comparative Study

THE LARYNGOSCOPE, Issue 2 2005
Johnny Cappiello MD
Abstract Objectives/Hypothesis: The objective was to compare the results of clinical and electrophysiological investigations of shoulder function in patients affected by head and neck carcinoma treated with concomitant surgery on the primary and the neck with different selective neck dissections. Study Design: Retrospective study of 40 patients managed at the Department of Otolaryngology, University of Brescia (Brescia, Italy) between January 1999 and December 2001. Methods: Two groups of 20 patients each matched for gender and age were selected according to the type of neck dissection received: patients in group A had selective neck dissection involving clearance of levels II,IV, and patients in group B had clearance of levels II,V. The inclusion criteria were as follows: no preoperative signs of myopathy or neuropathy, no postoperative radiotherapy, and absence of locoregional recurrence. At least 1 year after surgery, patients underwent evaluation of shoulder function by means of a questionnaire, clinical inspection, strength and motion tests, electromyography of the upper trapezius and sternocleidomastoid muscles, and electroneurography of the spinal accessory nerve. Statistical comparisons of the clinical data were obtained using the contingency tables with Fisher's Exact test. Electrophysiological data were analyzed by means of Fisher's Exact test, and electromyography results by Kruskal-Wallis test. Results: A slight strength impairment of the upper limb, slight motor deficit of the shoulder, and shoulder pain were observed in 0%, 5%, and 15% of patients in group A and in 20%, 15%, and 15% of patients in group B, respectively. On inspection, in group B, shoulder droop, shoulder protraction, and scapular flaring were present in 30%, 15%, and 5% of patients, respectively. One patient (5%) in group A showed shoulder droop as the only significant finding. In group B, muscle strength and arm movement impairment were found in 25% of patients, 25% showed limited shoulder flexion, and 50% had abnormalities of shoulder abduction with contralateral head rotation. In contrast, only one patient (5%) in group A presented slight arm abduction impairment. Electromyographic abnormalities were less frequently found in group A than in group B (40% vs. 85% [P = .003]), and the distribution of abnormalities recorded in the upper trapezius muscle and sternocleidomastoid muscle was quite different: 20% and 40% in group A versus 85% and 45% in group B, respectively. Only one case of total upper trapezius muscle denervation was observed in group B. In both groups, electroneurographic data from the side of the neck treated showed a statistically significant increase in latency (P = .001) and decrease in amplitude (P = .008) compared with the contralateral side. There was no significant difference in electroneurographic data from the side with and the side without dissection in either group. Even though a high number of abnormalities was found on electrophysiological testing, only a limited number of patients, mostly in group B, displayed shoulder function disability affecting daily activities. Conclusion: The study data confirm that clearance of the posterior triangle of the neck increases shoulder morbidity. However, subclinical nerve impairment can be observed even after selective neck dissection (levels II,IV) if the submuscular recess is routinely dissected. [source]

Triplication of the lesser occipital nerve

CLINICAL ANATOMY, Issue 8 2004
C. Madhavi
Abstract Triplication of the lesser occipital nerve (LON) was observed bilaterally in an adult male cadaver during routine prosection of the posterior triangle. The three LONs were studied to determine the clinical importance of this variation. The origin of one LON was from a nerve to the trapezius that had a common origin with the trunk of the supraclavicular nerve (C3,4) from the cervical plexus. Such a common origin of a LON may explain the pain referred to the shoulder and arm that is experienced by some patients with cervicogenic headache. Another LON ran across the roof of the posterior triangle, passed through the trapezius and was closely related to the point of exit of the greater occipital nerve (GON) from the trapezius. This LON supplied the nape of the neck, back of the scalp and the auricle. The anomalous course taken by this LON through the trapezius may be an explanation for cervicogenic headache precipitated by neck movement. The close relationship of this variant LON to the exit of the GON from the trapezius seems to be relevant to the management of cervicogenic headache. The authors suggest that the reason for the complete pain relief experienced by some patients with cervicogenic headache by anesthetic blockade of the GON may be because both the GON and LON are blocked simultaneously due to their proximity in these patients. Clin. Anat. 17:667,671, 2004. © 2004 Wiley-Liss, Inc. [source]

Lymph node metastases in the lower neck

CLINICAL OTOLARYNGOLOGY, Issue 3 2003
W. Giridharan
Lymph node metastases in the lower neck Current knowledge suggests that lymph node metastases in the lower neck (supraclavicular fossa and posterior triangle) are associated with a poor survival. Very little systematic work has been published on this subject. This was a retrospective study carried out on a database where all patients were entered in a prospective manner over a 35-year period using a standard pro-forma. Data on 168 patients presenting with a lower neck node metastasis were retrieved. The main outcome measures were: association between variables and tumour-specific survival. Data were displayed in contingency tables and analysed by chi-square and categorical modelling. Recurrence and survival were plotted in a cause-specific manner using the Kaplan Meir method. Differences in curves were analysed using the log rank test. Multivariate analysis was carried out using Cox's proportional hazard model. The only association was between site and node level and histology. Head and neck tumours were associated with squamous histology (P = 0.0004) and supraclavicular nodes (P = 0.0047). Survival time was not significantly different when lower-neck lymph node metastasis from the head and neck was compared to non-head and neck metastasis: 5-year survival 30% and 10% respectively (P = 0.1363). Survival with posterior triangle metastases was significantly better than supraclavicular metastases (P = 0. 0059), confirmed on multivariate analysis. Laterality of metastasis had no effect on survival (P < 0.0001). There was no significant difference in survival between squamous and non-squamous metastases on Cox regression (P = not significant). There were 85 head and neck primaries including lymphomas, 53 infraclavicular primaries and 30 unknown primaries. There were 73 squamous cell carcinomas, 27 adenocarcinomas, 34 lymphomas, 28 undifferentiated tumours and six other tumours. Nearly half the primary tumours were below the clavicle. Survival was unaffected by laterality, primary site or histology, but was better for posterior triangle nodes. [source]